Ankylosing Spondylitis, Chronic Fatigue and Depression Improved After Stromal Vascular Fraction Treatment for Osteoarthritis

A Case Report

Bora Bright; Ralph Bright; Pelin Bright; Amita Limaye

Disclosures

J Med Case Reports. 2018;12(238) 

In This Article

Discussion and Conclusions

Consistent with our findings, positive therapeutic effects of SVF have been shown in treatment of OA of hip and knee.[7] In 2011, based on a case series of 339 patients treated with SVF, Centeno et al. reported that 69% of patients were candidates for knee replacement.[13] However, after treatment with MSCs only 6.9% took up the option for replacement. Out of all the patients, 60% reported > 50% pain relief and 40% reported > 75% pain relief at 11 months.[13] We report here that SVF infusion given intravenously as well as intra-articularly was not only safe but effective in alleviating the pain associated with grade IV OA of hips and knee. HOOS and WOMAC scores showed 73% improvement over baseline (Figure 1b). HOOS and WOMAC questionnaires are both subjective measurements used to observe function following joint arthroscopy and arthroplasty procedures and are proven to be useful for the evaluation of patient-relevant outcomes.[14] Interestingly, her AS also showed improvements based on ASQoL: her ASQoL score decreased from 18 down to 3 after SVF treatment. We used the ASQoL to assess our patient's AS; the ASQoL questionnaire is a feasible method of determining a patient's quality of life.[15]

This is a first study reporting improvement of AS, a comorbidity, along with OA. In 2014, Wang et al. conducted an AS allogeneic stem cell treatment 20-week follow-up (ASAS20) study, which involved treating patients with AS via intravenous infusion of allogeneic cells with a 20-week follow-up.[16] The findings confirmed improvements via both objective MRI evaluations as well as subjective questionnaires. The responders showed 77.4% improvement based on the questionnaire assessment, and the MRI reports confirmed a decrease in inflammation.[16] These results are similar to the findings of the study described here, except for the use of allogeneic bone marrow-derived stem cells. Allogeneic and autologous cells are similar in nature, however, previous publications have shown autologous cells can be better in performance and safety when compared to allogeneic cells.[17,18] SVF contains a high number of adipose-derived stem cells (ASCs) that are reported to preferentially migrate toward injured, inflamed, or hypoxic tissues to promote regeneration.[19] Chemokines and cytokines play an important role in cell activation, survival, and differentiation as well as cell migration. Inflammation is a key biomarker in driving depression.[20,21] SVF plays a key role in suppressing inflammation; it thereby aids in repair and regeneration. Medications such as Lyrica (pregabalin), Nexium (esomeprazole), and Orudis (ketoprofen) have been associated with minor side effects of depression. We need to consider that possible reasons for improved depression could be related to a decrease in medication use, along with the immunomodulatory effects of SVF. The hypothesis in improving a patient's quality of life is not only due to improvements in arthritic changes, it can also be associated with suppressing the inflammatory biomarkers that are linked to depression. This original case report provides insight into the fact that SVF treatment has the potential to improve patients' quality of life by improving joint function and mobility, and decrease pain in patients with OA as well as AS. Further study utilizing multiple patients is required to arrive at conclusions on the effectiveness of this treatment for AS.

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